Viral Infections in

NICU
Dr. B. Hennebry
 Terminology
• Congenital

• Trans-placental

• Trans-amniotic

• Peri-partum

• Haematogenous
 Terminology
• Acquired

• Vertical transmission

• Breastmilk

• Horizontal transmission

• Siblings and family members

• Iatrogenic

• Healthcare workers

• Contaminated surroundings
 Congenital Infections

• Broad Principles

• The earlier the maternal infection the worse the

outcome.

• Primary infections are usually more severe in

their outcome.
 Diagnostic Challenges

• Subacute congenital infections have extremely

non-specific signs

• Subacute congenital infections have long-term

outcome implications
 Diagnostic Challenges

• Acute congenital infections have similar clinical

features

• Presenting and clinical features of acquired

infections may not be useful in differentiation
 Cytomegalovirus
• Large herpesviridae

• Multiple strains which may co-exist

• possibility for repeat infections with new strains

• Pro-inflammatory

• possible role of monocytes in invasive CMV

 Cytomegalovirus

• Congenital

• Wide range of presentations

• Most common infective cause of sensorineural

hearing loss

• Effective treatment exists

 Cytomegalovirus

• Acquired

• Common

• Uncertain significance
 Cytomegalovirus

• Diagnosis

• PCR

• Serological
 Cytomegalovirus

• Treatment

• Ganciclovir (valganciclovir)
 HSV

• Herpes simplex virus

• Carriage of HSV-1 may be as high as 90%

 HSV

• Congenital

• Usually associated with a re-activation of

genital herpes

• Be cautious of scalp electrodes

• Maternal history may be difficult to elicit

 HSV

• Acquired

• Less common in the neonatal period

• Associated with “cold sores”

 HSV

• Diagnosis

• PCR

• Symptoms of congenital HSV may not manifest

for several weeks
 Treatment

• Aciclovir
 Respiratory Tract
Viruses
• RSV

• May be transmitted from relatives or iatrogenically

• Scrupulous hand hygiene

• Cohorting affected patients

• Isolation procedures

• Call for help early

 Hepatitis

• Family of viruses often linked together

• Management is via vaccination and risk

stratification
 Enterovirus
• Commonly post-natally acquired

• May present with a broad range of symptoms

• Important differential for meningitis/encephalitis

• Supportive mangement

• May be associated with longer term cardiac

dysfunction
 Rubella

• Uncommon

• Incidence may increase as vaccination rates

drop

• Congenital defects are rare in maternal infections

after around 20 weeks gestation
 Parvovirus

• Small DNA virus

• Causes foetal anaemia and hydrous secondary

to a direct suppression of bone marrow
precursors.

• No specific treatment or vaccination available

 HIV

• Should be managed in conjunction with an ID

specialist team

• Anti-retroviral therapy should be started early

and continued

• Diagnosis may be delayed due to non-disclosure

 Complications of Viral
Infections

• Diagnosis

• Maternal diagnosis may be difficult

• Symptomatology may be non-specific

• Testing may be slow

 Complications of Viral
Infections

• Management

• Often have no specific treatment

• There may be confusion as to duration of

treatment
 Complications of Viral
Infections

• Screening?
Thank You

Questions